2013～2015年血流感染患者的病原体种类及耐药性分析

Species of pathogenic bacteria and drug resistance in patients with loostream infections: a 3-year analysis from 2013 to 2015

摘要:

了解血流感染（BSI）的病原体分布及其耐药性，为临床合理应用抗菌药提供依据。方法对2013～2015 年铜陵市人民医院BSI 患者血培养分离的病原体资料进行统计分析。结果595 株病原体中，革兰阳性菌占50.3%（299/595），革兰阴性菌占48.7%（290/595），真菌占1.0%（6/595）。居前6 位的病原体依次为凝固酶阴性葡萄球菌（CNS）（30.6%）、大肠埃希菌（21.5%）、克雷伯菌属（9.1%）、肠球菌属（6.4%）、金黄色葡萄球菌（SA）（5.9%）和不动杆菌属（5.0%）。甲氧西林耐药金黄色葡萄球菌（MRSA）和甲氧西林耐药凝固酶阴性葡萄球菌（MRCNS）分别占SA 和CNS 的34.3%和76.9%。葡萄球菌属中未发现万古霉素、替考拉宁和利奈唑胺耐药 株。粪肠球菌对青霉素G、氨苄西林、万古霉素、替考拉宁和利奈唑胺无耐药；屎肠球菌对万古霉素和替考拉宁耐药率达23.5%，对利奈唑胺无耐药。大肠埃希菌和克雷伯菌属中产ESBLs株分别占50.8%和38.9%；大肠埃希菌对碳青酶烯类耐药率在1.0%以下；克雷伯菌属及肠杆菌属对碳青酶烯类耐药率分别达27.8%和18.2%。不动杆菌属对碳青霉烯类耐药率达70.0%以上。结论BSI 分离的病原体以革兰阳性菌为主，CNS 和大肠埃希菌是其最常见的病原体。应重视BSI病原体耐药性监测，加强抗生素的合理使用。

Abstract:

To investigate the distribution and antibiotic resistance of clinical isolates from blood culture, and to guide the rational use of antimicrobial agents. Methods Data of pathogens isolated from blood specimens of the patients with bloodstream infections in Tongling People's Hospital from 2013 to 2015 were statistically analyzed. Results Of the 595 strains isolated from blood samples, Gram-positive bacteria, Gram negative bacteria and fungi accounted for 50.3% (299/595), 48.7% (290/595) and 1.0% (6/595) respectively. The top six pathogens were coagulase-negative (CNS, 30.6%), (21.5%), (9.1%),(6.4%), (SA, 5.9%) and (5.0%). Methicillin-resistant (MR) SA and MRCNS accounted for 34.3 % of and 76.9 % of CNS, respectively. No strain was found resistant to Vancomycin, Teicoplanin or Linezolid in . No strain was found resistant to Penicillin, Ampicillin, Vancomycin, Teicoplanin or Linezolid in . No strain was found resistant to Linezolid in . Vancomycin-resistant and Teicoplanin-resistant accounted for 23.5% of the isolates. About 50.8% of the isolatesand 38.9 % of the isolates produced extended-spectrum β-lactamases (ESBLs). Less than 1.0% of the isolates, about 27.8 % of the isolates and 18.2% of the . isolates, and more than 70.0% of the isolates were resistant to Carbapenems. Conclusions Gram-positive cocci are the major pathogens causing bloodstream infections in this hospital. CNS and are the most common pathogens. We should pay more attention to resistance surveillance and rational use of antibiotics.